[Treatments of metastases in cancer]

Intravenous bisphosphonates or denosumab are a key component for the treatment of bone metastases. Their efficacy on the frequency and the number of skeletal events has been clearly shown. They also exhibit some variable activity on metastatic bone pain. Most often, the side effects of IV bisphosphonates are well-tolerated. However, new and more severe side effects have also been reported, with an increasing incidence. These toxicities regard the bone (osteonecrosis of the jaw) and the kidneys (acute renal failure) and are considered a class effect of bisphosphonates (varying by their potency) and prevention is mandatory. Recent data on denosumab have led authorities to suggest no need for renal monitoring in patients treated with this drug. However, as renal function changes are frequent in cancer patients, and have implications for many treatments, we suggest that calculated creatinine clearance should be regularly checked.